More than 1.7 million people in Malawi live with disabilities, but the hospital system is not set up for them, so they suffer indignity and worse. (Photo by Anthony ASAEL/Gamma-Rapho via Getty Images)
Malawian Christian Chibisa’s antenatal visits to a local health facility were confusing and frustrating. She is nonverbal and Limbe Health Centre in Blantyre did not have any sign language interpreters.
“I tried to explain how unusual I felt but was ignored. The nurse on duty just did a physical examination, jotted something in the health passport, and sent me off.”
She shared her experience with The Continent through a sign language interpreter, while breastfeeding her nine-month-old baby girl.
To deliver her baby, Chibisa played it safe by having her sister go with her to the facility.
“She helped me with communication.”
Being able to communicate with nurses proved critical because Chibisa didn’t recover well enough after delivery, requiring referral to a bigger facility.
When The Continent visited three of Blantyre’s most important health facilities, Limbe, Queen Elizabeth Central Hospital and the Zingwangwa health centre, none had an interpreter. None had bathrooms or ambulances fitted to be accessible for people with mobility challenges. The height of delivery and examination beds could not be adjusted.
“The labour ward is almost inaccessible for us,” said Lynes Manduwa, a disability rights advocate.
These limitations occur across Malawian public hospitals, forcing adult patients like Chibisa to rely on “guardians” as interpreters and assistants to use bathrooms and other amenities. These limitations are worse in rural Malawi and have persisted for decades.
When Fanny Malemia had an ectopic pregnancy in 2018, the absence of sign interpreters nearly cost her life. Her life-threatening condition was not treated at the Zingwangwa health centre because her husband is also non-verbal and could not translate her pain to the nurses.
Malemia only got surgery when her pastor’s wife agreed to escort them to Queen Elizabeth. The delay, and inability to get full information from the doctors, left Malemia worried that she would not be able to conceive again.
“I endured a double psychological battle. This also disturbed my relationship with my husband until I became pregnant again a year later,” Malemia said through a sign interpreter.
Health workers’ prejudice sometimes makes the indignities worse.
“Recently, one woman was slapped during labour because the nurses and the patient couldn’t communicate,” Bryson Chimenya, who heads the Malawi National Association for the Deaf, told The Continent in July.
That kind of situation has persisted for decades. Manduwa said that, when she had her baby in 1992, nurses confronted her husband about impregnating a disabled woman.
Formal training for Malawian health workers barely covers caring for people with disabilities. According to Christopher Namagowa, the registrar at Kamuzu University of Health Sciences, Malawi’s major medical training institution, only cursory content on disability care is included in the four-year nursing programme.
The government appears to be far better at talking about disability than actually helping disabled people.
The country is party to progressive international treaties like the UN Convention on the Rights of Persons with Disabilities and the African Disability Protocol.
It passed disability legislation in 2012 and improved it this year. But, according to last year’s review of the implementation of the UN convention, there are only 10 qualified sign language interpreters in Malawi.
Most work as on-screen news interpreters. In crucial areas, like hospitals, interpretation is left to unqualified friends and family — if anyone.
Doreen Ali, the director of reproductive health services in Malawi, conceded that inaccessible infrastructure and health workers without the appropriate training have led to poor treatment for women with disabilities. But she said the ministry has a plan to better train staff through the pre-service curriculum.
The government has a poor track record for following through on its stated plans. A 2018 five-year national strategy on improving disability services included the aim for “the highest attainable standard of health for persons with disabilities”.
When it expired last year, there was little to show for that.
Aware of the government’s dismal record, independent activists are instead working with allies such as Sight Savers and UK Aid Match to train health workers.
This story was supported by the Pulitzer Center through the Underreported Stories in Africa project
This article first appeared in The Continent, the pan-African weekly newspaper produced in partnership with the Mail & Guardian. It’s designed to be read and shared on WhatsApp. Download your free copy here.
